Other Diseases
Any illness that compromises pulmonary or cardiovascular function will affect how well tissues are perfused and/or oxygenated. Oxygen is an important factor for cell metabolism, especially energy production process of adenosine triphosphate (ATP), which drives the majority of cellular processes during wound healing. It is critical for nearly all wound-healing processes.
Oxygen prevents wounds from developing infection, stimulates angiogenesis, increases keratinocyte differentiation, migration and re-epithelialization, enhances fibroblast proliferation and collagen synthesis, and promotes wound contraction (Guo & DiPieto, 2010; Kimmel et al., 2016).
Due to pulmonary and cardiovascular systems being compromised, the flow of oxygen is impaired. When combined with high consumption by metabolically active cells, the microenvironment of the early wound can become quite hypoxic.
From the perspective of wound healing, the result of poor perfusion creates a hypoxic wound that inhibits fibroblast replication and impairs the production of collagen. The healing process can become impaired, which can delay/stall wound healing at any or all of the wound healing stages. Without good blood flow and oxygen, tissue begins to die, potentially leading to necrosis (Diego et al., 2012; Kimmel et al., 2016). Even though acute hypoxia stimulates wound healing, tissue oxygenation is required to sustain the healing process.
A large number of diseases/illnesses can affect perfusion and oxygenation in this way. A few examples are listed here:
Circulatory Disorders
- Aneamia
- PAD
- Hypovolemia
- Heart failure
- Arteriosclerosis
- Hypertension
Respiratory Disorders
- Chronic obstructive airways disease (COPD)
- Pneumonia
- Bronchitis
Other
- Sepsis
Underlying Medical Conditions
There are many other disorders that will delay wound healing. They can be thought of under the following headings. A few examples are listed under each heading, but this is not an exhaustive list:
These diseases can cause an increase in the levels of inflammatory and oxidative stress markers as well as a rise in metalloproteases. Furthermore, there is a higher risk of vascular deficiency, which can lead to undersupplied oxygen and diminished levels of essential nutrients delivered to the tissue. There is also a greater susceptibility to infection. (Swanson et al., 2014; Avishai et al., 2017)
- Diabetes
- Renal & hepatic failure
These disorders often mean that the body is unable to absorb fats, protein, or certain sugars or vitamins, resulting in a deficiency of that nutrient, which will ultimately delay wound healing.
- Crohn’s disease
- Ulcerative colitis
Neurological damage, loss of sensation and mobility can increase the propensity to developing wounds, particularly pressure ulcers/injuries (Wound Source, 2014).
- Cerebrovascular event (CVE)
- Diabetes
- Multiple sclerosis
- Spinal injury
- Neuropathy
These diseases and the medications required to treat them, can compromise the immune system, which raises the risk of infection and the body's inflammatory responses (Avishai et al., 2017).
- Rheumatoid arthritis
- Malignancy
- HIV, AIDS
(Benbow, 2007)